Provider Demographics
NPI:1689689549
Name:BARRY M. RAPP, M.D., PROF. LLC
Entity Type:Organization
Organization Name:BARRY M. RAPP, M.D., PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-595-7700
Mailing Address - Street 1:1619 N GREENWOOD ST
Mailing Address - Street 2:SUITE #106
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2644
Mailing Address - Country:US
Mailing Address - Phone:719-595-7700
Mailing Address - Fax:719-595-7719
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:SUITE #106
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2644
Practice Address - Country:US
Practice Address - Phone:719-595-7700
Practice Address - Fax:719-595-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO485728Medicare ID - Type Unspecified